Subclavian artery injury, vertebral artery dissection, and arteriovenous fistulae following attempt at central line placement

Vertebral artery dissection and arteriovenous fistulas are uncommon complications of vascular access and angiographic procedures. There are several cases of iatrogenic vertebral artery dissection secondary to central line placement reported in the literature. Only a few iatrogenic arteriovenous fistulae have been reported, but none also involving the dissection of the vertebral artery. In each of these cases, the fistulae were treated by direct ligation of the fistulous communication. We present an unusual case of an iatrogenic arteriovenous fistula and vertebral artery dissection as a result of left subclavian central line placement. The left subclavian artery and associated fistula were successfully repaired using a self-expanding endovascular graft.